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Plasmodiasis(Malaria)

Nov 10, 2016,
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Malaria is a potentially life-threatening disease caused by infection withPlasmodium protozoa transmitted by an infective female Anopheles mosquito.Plasmodium falciparum infection carries a poor prognosis with a high mortality if untreated, but it has an excellent prognosis if diagnosed early and treated appropriately. See the image below.

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Malarial merozoites in the peripheral blood. Note that several of the merozoites have penetrated the erythrocyte membrane and entered the cell.

See 11 Travel Diseases to Consider Before and After the Trip, a Critical Images slideshow, to help identify and manage infectious travel diseases.

Signs and symptoms

Patients with malaria typically become symptomatic a few weeks after infection, though the symptomatology and incubation period may vary, depending on host factors and the causative species. Clinical symptoms include the following:

Histologically, the various Plasmodiumspecies causing malaria may be distinguished by the following:

Presence of early forms in peripheral blood

Multiply infected red blood cells

Age of infected RBCs

Schüffner dots

Other morphologic features

See Workup for more detail.

Management

Treatment is influenced by the species causing the infection, including the following:

Plasmodium falciparum

P vivax

P ovale

P malariae

P knowlesi

In the United States, patients with P falciparum infection are often treated on an inpatient basis to allow observation for complications. Patients with non– P falciparum malaria who are well can usually be treated on an outpatient basis.

General recommendations for pharmacologic treatment of malaria are as follows:

P falciparum malaria with known chloroquine susceptibility (only a few areas in Central America and the Middle East): Chloroquine

P vivax, P ovale malaria: Chloroquine plus primaquine

P malariae malaria: Chloroquine

P knowlesi malaria: Same recommendations as for P falciparummalaria

Pregnant women (especially primigravidas) are up to 10 times more likely to contract malaria than nongravid women and have a greater tendency to develop severe malaria. Medications that can be used for the treatment of malaria in pregnancy include the following: